23例炎性迷路瘘管的手术治疗

目的:总结炎性迷路瘘管的手术治疗经验。方法:回顾分析手术修复迷路瘘管23例的临床资料。均清除胆脂瘤基质及瘘管周围炎性病变,<2 mm的瘘管7例单用筋膜覆盖;2～3 mm的瘘管13例用小骨片填塞,外盖筋膜;>3 mm的3例瘘管用筋膜填塞瘘管两端骨管腔内,以骨片及筋膜填塞瘘管。结果:23例中,术后2例失访,余21例平均随访2.5年,19例干耳,17例眩晕消失;除术前2例全聋外,19例术后语频气导69.1 dB HL,骨导30.6 dB HL。结论:除瘘管试验外,术前岩骨轴位CT扫描有重要诊断价值。由于上下迷路之间的解剖屏障和炎性分隔,手术封闭迷路瘘管是可行的。手术成功关键是精湛的耳显微手术技巧,彻底清除病灶,可靠封闭或填塞瘘管,辅以抗炎及类固醇治疗,坚持术后治理。     

慢性化脓性中耳炎并发迷路瘘管的手术治疗

目的探讨慢性中耳炎迷路瘘管的临床特点及手术方法.方法对63耳有迷路瘘管的胆脂瘤型和骨疡型中耳炎行乳突根治术的同时用颞肌筋膜或同种肋软骨片加筋膜一期修复瘘管.结果1718耳慢性中耳炎中并发迷路瘘管63耳,其中胆脂瘤型60耳,在各型中耳炎中发生率最高,骨疡型3耳.瘘管位于外半规管56耳(88.9%),耳蜗2耳,上半规管3耳,外半规管和上半规管同时有瘘管2耳.63耳中术前有眩晕症状的37耳(58.7%),其中瘘管试验阳性13耳(35.1%).有眩晕症状耳平均骨导阈值为40.1dB,无眩晕症状耳为33.2dB.除1耳外,全部病例行瘘管一期修复后,眩晕症状消失.结论用同种异体肋软骨片加筋膜修复慢性中耳炎迷路瘘管是较理想的方法,对瘘管大、病变重者应行二期手术.     

胆脂瘤型中耳炎并发迷路瘘管的手术治疗

目的探讨胆脂瘤型中耳炎并发迷路瘘管的临床特征及手术治疗方法。方法回顾性分析胆脂瘤型中耳炎并发迷路瘘管20例患者的临床资料,其中2例行开放式乳突根治及鼓室成形术,16例行开放式乳突根治术,2例行乳突再次根治术。结果全部患者一期修复瘘管,术后随访眩晕症状明显改善。纯音测听平均骨导阈值（0．5、1、2、4kHz）,12例术后听力无明显变化,2例术后听力有不同程度的提高,6例术后听力有轻度下降,平均下降15dB以上。结论对胆脂瘤型中耳炎患者应高度重视迷路瘘管存在的可能性,手术时应彻底清除瘘管区病变、修补瘘孔。     

胆脂瘤型中耳炎并发迷路瘘管的手术治疗

目的探讨胆脂瘤型中耳炎并发迷路瘘管的手术方法与疗效。方法对1998年1月-2007年1月手术治疗的胆脂瘤型中耳炎并发迷路瘘管20例（耳），全部病例行一期修复瘘管，其中行单纯筋膜修复9耳，行自体骨粉加筋膜修复11耳。结果术后随访1-10年，单纯筋膜修复术后转动头部仍有眩晕者2耳，自体骨粉加筋膜修复者术后无眩晕发生。结论胆脂瘤型中耳炎并发迷路瘘管，清除病灶后可以一期修复，用自体骨粉加筋膜修复迷路瘘管是较理想的方法。     

胆脂瘤性中耳炎并发迷路瘘管的诊断与治疗

迷路瘘管是胆脂瘤性中耳炎最常见的并发症 ,其早期临床特征常不典型 ,易漏诊、误诊。为了增加对本病的认识 ,特将我院 1 985年 8月～ 1 999年 3月收治的 3 1例胆脂瘤性中耳炎并发迷路瘘管者的资料报告如下。1　资料与方法1 .1 　 临床资料3 1例 (3 1耳 )中 ,男 1 8例 ,女 1 3例 ;年龄 1 5～6 8岁 ,平均 40 .2岁。左耳 2 3例 ,右耳 8例。有反复耳流脓史 2 8例 ,否认流脓史 3例。1 2例有前庭紊乱症状 ,1 4例有头晕或间歇性眩晕发作 ,5例有持续性眩晕。病程 0 .6～ 3 0年。检查示鼓膜大穿孔者 2 2例 ,松弛部穿孔 9例 ,其中鼓膜大穿孔乳突自然根…     

中耳胆脂瘤并发迷路瘘管的术后听力回顾性研究

目的探讨手术治疗对中耳胆脂瘤并发迷路瘘管患者听力的影响。方法回顾性分析35例（35耳）中耳胆脂瘤并发迷路瘘管患者的临床资料;其中21例（21耳）患者随访术后听力情况。结果21例（21耳）术后随访纯音测听3个月～5年,12例平均骨导阈值（0．5、1、2,N4kHz）与术前差别小于5dBHL,较术前听力提高者3例,较术前下降者5例,1例于术后3个月成功植入人工耳蜗。21例患者中11例行开放式乳突切开＋鼓室成形术,其手术前后骨气导各频率间（0．5、1、2、4～118kHz）听力阈值未见明显差异（配对样本t检验,P值均大于0．05）。结论中耳胆脂瘤并发迷路瘘管的术后骨导听力阈值无明显变化,有条件者仍可行鼓室成形术保存听力。     

慢性化脓性中耳炎并发迷路瘘管的临床特征和手术治疗

目的 探讨慢性化脓性中耳炎并发迷路瘘管的临床特征及其手术治疗方法。方法 回顾性分析1996～2003年经手术确诊的慢性化脓性中耳炎并发迷路瘘管的22例(23耳)患者的临床资料。结果 22例(23耳)中,术前主诉眩晕者 9 例(39.1 %),瘘管试验阳性 8例(34.8 %),薄层颞骨CT扫描提示迷路瘘管10 例(50 %)。术中见胆脂瘤型中耳炎 22耳(95.7 %),骨疡型中耳炎1耳(4.3 %)。瘘管发生于外半规管19耳(82.6 %),后半规管3耳(13.0 %),同时累及上半规管和外半规管1耳(4.3 %),同时累及上半规管和后半规管1耳(4.3 %)。结论 迷路瘘管术前缺乏可靠的依据诊断。几乎是胆脂瘤型中耳炎独有的并发症,最常见于外半规管。术中对瘘管的处理应根据瘘管的大小、类型、部位及患者术前听力状况而定。     

迷路瘘管的研究进展

迷路瘘管是慢性胆脂瘤型中耳炎的常见并发症。本就其发病因素、临床表现、术前诊断、手术治疗以及预后等方面的研究进展进行了综述。     

中耳胆脂瘤并发迷路瘘管的临床特征

目的 探讨中耳胆脂瘤并发迷路瘘管的诊断和处理方法.方法 回顾分析2012年9月至2018年9月在我院住院行中耳胆脂瘤手术患者658例,其中并发迷路瘘管52例(7.9％),收集其术前临床表现、纯音听阈结果、影像学表现,术中探查所见及处理方式,术后恢复情况等结果进行统计学分析.结果 52例迷路瘘管患者术前有眩晕症状32例(...     

中耳炎手术中迷路瘘管的再讨论

文中对1990～1997年耳科住院手术病例中51例迷路瘘管进行了讨论,迷路瘘管的位置除一例合并后半规管瘘管外,其余病例均为外半规管瘘,而且瘘管大小和术前骨导听力无明显关系.其中有34例是胆脂瘘.所有病例中除一例胆脂瘤上皮残留术后骨导听力有下降外,其余都保持了术前的骨导听力.     

Surgical management of labyrinthine fistula in chronic otitis media with cholesteatoma

Objective

To present the surgical outcomes of complete removal of the matrix of labyrinthine fistulas in a large series of middle ear cholesteatomas.

Patients and methods

This is a retrospective study. We analyzed 38 of 778 patients who were operated on for cholesteatoma and were proved to have labyrinthine fistula from 1991 to 2007. For this study, a more aggressive strategy was adopted that compromised immediate total removal of the matrix, regardless of size. To evaluate the safety and efficacy of the procedure, pre and postoperative pure-tone audiometry were compared and the recurrence rate was analyzed. Relevant data from the literature using a wide array of strategies were compared with our results.

Results

Only two patients suffered from postoperative hearing deterioration of bone conduction of more than 10 dB HL. There was no relationship between the size of labyrinthine fistulas and postoperative hearing deterioration. Recurrence of labyrinthine fistulas was not found.

Conclusions

Total removal of the cholesteatoma matrix in one step is a safe and effective method for the treatment of labyrinthine fistulas.     

胆脂瘤型中耳炎并发迷路瘘管38例临床分析

目的分析胆脂瘤型中耳炎并发迷路瘘管的临床特征,总结其诊治经验和体会。方法回顾性分析我科2000年7月至2010年12月收治的38例经手术证实为胆脂瘤型中耳炎并发迷路瘘管患者的临床资料,38例患者均在全麻下行乳突根治术,术中一期清除瘘管处胆脂瘤及肉芽,Ⅰ型、Ⅱ型瘘管取双层颞肌筋膜覆盖封闭瘘口,Ⅲ型瘘管行半规管阻塞术。结果胆脂瘤型中耳炎并发迷路瘘管的发生率为8.2%(38/464),术中发现瘘管全部位于水平半规管,术后所有患者均获干耳,眩晕未再发作,干耳后平均骨导听阈与术前相比无明显差异。结论迷路瘘管的确诊有赖于手术中发现证实;只要术中精细操作并采用合适的方法修补瘘管,一期彻底清除瘘管处病变可以同时有效地保存耳蜗功能;对于病变广泛的Ⅲ型瘘管,半规管阻塞术是一个安全、有效的治疗方法。     

Surgical treatment of cholesteatomatous labyrinthine fistula by hydrodissection

Middle ear cholesteatoma is a destructive lesion that can potentially erode the bone. Cholesteatoma is a clinical diagnosis in the vast majority of cases. Patients must be systematically investigated for the presence of signs suggestive of complications, the most common of which is labyrinthine fistula. However, the clinical features of labyrinthine fistula are inconstant and the fistula sign may sometimes be negative. CT scan of the petrous temporal bone is performed systematically to specify the site and extension of the cholesteatoma, and to assess the extent of osteolysis that can result in exposure of the membranous labyrinth. Surgical treatment has three main objectives: complete resection of the cholesteatoma, which is the only way to avoid residual cholesteatoma, prevention of recurrence by an adapted, preferably one-step, technique, and restoration of good quality hearing. Hydrodissection of the cholesteatoma matrix in the presence of labyrinthine fistula is a simple technique that can achieve the three main general objectives of cholesteatoma surgery.     

Long-term deterioration of bone-conduction hearing level in patients with labyrinthine fistula

Objective

Although many reports describe the short-term hearing outcomes of surgically managed labyrinthine fistulae, the long-term results remain unknown. We reviewed the long-term postoperative hearing outcomes of 14 ears of patients with cholesteatoma and labyrinthine fistulae.

Methods

Between 1996 and 2010, 84 patients with cholesteatoma and labyrinthine fistula underwent tympanoplasty at Hyogo College of Medicine Hospital. Fistulae were located in the lateral semicircular canal in all patients and in the superior semicircular canal in one. Fourteen patients were followed up for more than 5 years.

Results

The postoperative air-bone gap was ≤10 dB in one patient, between 11 and 20 dB in seven, between 21 and 30 dB in four, and ≥31 dB in two. Mean bone-conduction hearing levels on the operated side had deteriorated by 3, −1 and −2 dB at 1, 2 and 4 kHz, respectively at 1 year postoperatively, and by 8, 6 and 2 dB at 1, 2 and 4 kHz, at 5 years postoperatively. Bone-conduction hearing levels at 1 and 2 kHz were significantly deteriorated at 5 years postoperatively, compared with baseline and 1 year (P < 0.05).     

Canal wall window mastoidectomy for extensive labyrinthine cholesteatoma: total dissection and hearing preservation

This case report highlights outcomes of a 6-year-old patient who preserved functional hearing after complete dissection of an extensive labyrinthine cholesteatoma causing two semicircular canals fistulas with endolymph leak, tympanic and labyrinthine fallopian canal erosion of the facial nerve and internal auditory canal invasion with cerebrospinal fluid leak. The patient preserved 40 dB average of bone conduction threshold and 92% of speech discrimination score at 26 months postoperatively. This article reveals that canal wall window mastoidectomy might be an option even in cases of extensive cholesteatomatous labyrinthine fistula therefore avoiding hearing loss and long life cleaning of a canal wall down mastoid cavity.